BENIGN SKIN NEOPLASMS

KRISTY L. ZADORA · 2026 · Case ID: 26002953

MIXED

Summary

The veteran, who served from July 1980 to July 1984, appeals the denial of service connection for a right shoulder lipoma and the remand of claims for bilateral eye disorders. The Board denied the right shoulder lipoma claim, finding that the veteran's service treatment records were negative for any complaints or diagnoses related to a lipoma. While the veteran asserted toxic exposure at Fort McClellan and El Toro, and the AOJ conceded exposure to various substances including radioactive compounds and herbicides, the VA examiners in April and May 2025 concluded that a lipoma is a benign tumor with an unknown cause and is not linked to toxic exposures. The Board found these opinions adequate and probative, noting that lipomas are common and not presumptive or radiogenic diseases. Furthermore, the Board afforded greater weight to the Veteran's service separation medical examinations which found no tumors or growths, over later statements suggesting onset in the 1980s. The Board denied service connection for the lipoma. The claims for bilateral eye disorders were remanded due to an inadequate VA opinion from November 2024. The examiner's conclusion that pterygia did not progress from a service-diagnosed pinguecula was inconsistent with service records showing a pterygium diagnosis. Additionally, the opinion did not address bilateral cataracts diagnosed after service, nor did it consider the most recent toxic exposure risk activity memorandums. On remand, the VA is to obtain updated records, provide adequate opinions on the nature and etiology of the Veteran's eye conditions (including dry eye, blepharitis, nuclear cataracts, conjunctivitis, pinguecula, and pterygia) in relation to toxic exposures, and address whether the pinguecula/pterygia pre-existed service or were aggravated by service.

Rationale

Service treatment records negative for lipoma; VA opinions found lipoma cause unknown and unrelated to toxic exposures; Service separation exams found no tumors/growths

Special Benefit

NO SPECIAL BENEFIT

Docket No.

16-22 921

Full Decision Text

Citation Nr: 26002953
Decision Date: 03/04/26 Archive Date: 03/04/26

DOCKET NO. 16-22 921
DATE: March 4, 2026

ORDER

Service connection for a right shoulder lipoma is denied.

REMANDED

Entitlement to service connection for bilateral eye disorders is remanded.

FINDING OF FACT

The right shoulder lipoma did not have onset during and is not otherwise related to service.

CONCLUSION OF LAW

The criteria for service connection for a right shoulder lipoma have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from July 1980 to July 1984.

This appeal comes to the Board from July 2013 and September 2014 rating decisions of a Department of Veterans Affairs (VA) Agency of Original Jurisdiction (AOJ). This appeal was initiated before the application of the Appeals Modernization Act (AMA), and these claims are being adjudicated under the Legacy appeal system.

These matters have previously been before the Board in August 2019 and January 2022 and were remanded to the Agency of Original Jurisdiction (AOJ) for additional development. Specifically, the claim for service connection for right shoulder lipoma to obtain updated treatment records, to attempt to verify the Veteran's asserted in-service exposure to toxic chemicals at Fort McClellan and El Toro and to obtain an etiology opinion. Updated VA treatment records have been associated with the claims file and a February 2022 letter requested that the Veteran complete an appropriate authorization form to allow VA to obtain treatment records on his behalf. A toxic exposure risk memorandum was issued by VA on January 2025. A VA etiology opinion was obtained in April 2025. The Board therefore determines that there has been substantial compliance with regards to the claim for service connection for a right shoulder lipoma. See Stegall v. West, 11 Vet. App. 268, 271 (1998); D'Aries v. Peake, 22 Vet. App. 97, 105 (2008).

A May 2025 rating decision granted the Veteran's claims for service connection for prostate cancer post radical prostatectomy with voiding dysfunction, chloracne, sores on the back of the head/surgical removal and erectile dysfunction and assigned an initial rating for each disability. The May 2025 rating decision also awarded special monthly compensation based on the loss of use of a creative organ. As this decision represents a full grant of the benefits sought with respect to this claim for service connection as well as special monthly compensation based on the loss of use of a creative organ, such issues are no longer before the Board for consideration. See Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1977).

Service Connection Criteria

Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). "To establish a right to compensation for a present disability, a veteran must show: "(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service"- the so-called "nexus" requirement." Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

Certain chronic diseases will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service, if they manifested to a compensable degree within a presumptive period following separation from service, or if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). A lipoma is not one of these enumerated diseases; thus, presumptive service connection under these regulations do not apply here
service, if they manifested to a compensable degree within a presumptive period following separation from service, or if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). A lipoma is not one of these enumerated diseases; thus, presumptive service connection under these regulations do not apply here.

In addition, the AOJ has conceded that the Veteran was exposed to radioactive compounds during service at Fort McClellan. Service connection for a disability claimed to be attributable to exposure to ionizing radiation during service can be demonstrated by three different methods. See Hilkert v. West, 12 Vet. App. 145 (1999); aff'd, 232 F.3d 908 (Fed. Cir. 2000). First, there are certain types of cancer that are presumptively service-connected specific to radiation-exposed veterans under 38 U.S.C. § 1112(c); 38 C.F.R. § 3.309(d). Second, service connection may be established under 38 C.F.R. § 3.303(d) with the assistance of the procedural advantages prescribed in 38 C.F.R. § 3.311 if the condition at issue is a "radiogenic disease." See 38 C.F.R. § 3.311(b)(2), (4). Third, under 38 C.F.R. § 3.303(d), direct service connection may be granted for any disease diagnosed after service discharge when the evidence establishes that the disease was incurred in service.

Certain specified disabilities becoming manifest in a "radiation-exposed veteran" shall be service connected. See 38 U.S.C. § 1112(c)(1), (2); 38 C.F.R.

§ 3.309(d)(1), (2). The term "radiation-exposed veteran" means a veteran who participated in a "radiation-risk activity." See 38 U.S.C. § 1112(c)(3)(A); 38 C.F.R. § 3.309(d)(3)(i). Here, the Veteran is not a "radiation exposed veteran" because he did not participate in any of the enumerated events listed in the regulation. 38 U.S.C. § 1112(c)(3)(B); 38 C.F.R. § 3.309(d)(3)(ii); 67 Fed. Reg. 3,612-16 (Jan. 25, 2002). Furthermore, a right shoulder lipoma is not a radiogenic disease; thus, the development under 38 C.F.R. § 3.311 is not required.

However, as noted above, presumptive service connection does not preclude a veteran from establishing service connection with proof of actual direct causation. See 38 C.F.R. § 3.303(d); Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). Thus, direct service connection based on exposure to radioactive compounds has been considered and is discussed further below.

The veteran can provide competent reports of factual matters of which he has first-hand knowledge, such as experiencing pain in service, reporting to sick call, being placed on limited duty, and undergoing physical therapy. See Washington v. Nicholson, 19 Vet. App. 362, 368 (2005). Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a lay person is competent to identify the medical condition (noting that sometimes the lay person will be competent to identify the condition where the condition is simple, for example a broken leg, and sometimes not, for example, a form of cancer), (2) the lay person is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. See Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007). Similarly, laypersons are competent to diagnose and provide nexus opinions to some extent, notably where the diagnosis or opinion is not of a complex nature. Id., see also Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009).

The determination as to whether the requirements for service connection are met is based on an analysis of all the evidence of record and the evaluation of its credibility
cancer), (2) the lay person is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. See Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007). Similarly, laypersons are competent to diagnose and provide nexus opinions to some extent, notably where the diagnosis or opinion is not of a complex nature. Id., see also Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009).

The determination as to whether the requirements for service connection are met is based on an analysis of all the evidence of record and the evaluation of its credibility and probative value. 38 U.S.C. § 7104(a); Baldwin v. West, 13 Vet. App. 1 (1999). When there is an approximate balance of positive and negative evidence as to any issue material to the determination of a matter, VA will resolve reasonable doubt in favor of the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc).

1. Service connection for a right shoulder lipoma is denied.

The Veteran seeks service connection for a right shoulder lipoma. He asserts that it is related to toxic risk exposure activities at Fort McClellan and El Toro Marine Corps Air Station. See May 2022 statements in support of claim, April 2022 statement from M.M., and May 2022 statements from F.Z., J.T., and T.T. The Veteran has a currently diagnosed right shoulder lipoma. See April 2025 VA examination report; see also, August 2008 VA treatment record.

Service treatment records are negative for complaints, treatments or diagnoses related to a right shoulder lump or lipoma. A November 1979 Report of Medical Examination at enlistment found the Veteran's skin and upper extremities to be clinically normal and the Veteran did not report a lipoma or right shoulder lump on the corresponding November 1979 Report of Medical History at enlistment. The June 1984 Report of Medical Examination for discharge found the Veteran's skin and upper extremities to be clinically normal.

A December 2024 toxic exposure risk activity memorandum noted that the Veteran was exposed at the superfund site of Fort McClellan, as well as exposed to jet fuel, airplane exhaust, and polychlorinated biphenyls (PCBs). In addition, an April 2025 addendum toxic exposure risk activity memorandum conceded that the Veteran was exposed to herbicide agents, cesium-137, cobalt-60, mustard gas, nerve agents, airborne PCBs, volatile organic compounds (VOCS), trichloroethylene (TCES), PCBS, semi volatile organic compounds (SVOCS), pesticides, explosives, heavy metals (PB), unexploded ordinance (UXO), radioactive sources, and non-stockpile chemical materials.

The AOJ issued an amended toxic exposure risk activity memorandum in May 2025 with additional toxic exposure risk activities, including herbicide agents 2, 3, 7, 8 (TCDD), radioactive compounds (cesium-137 and cobalt-60), chemical warfare agents (mustard gas and nerve agents), airborne PCBs from a Monsanto plant in Anniston, Alabama, volatile organic compounds (VOCs), Trichlorethylene (TCEs), PCBs, semi volatile organic compounds (SVOCs), pesticides, explosives, heavy metals (Pb), unexploded ordinance (UXO), radioactive sources, and non-stockpile chemical materials.

Post active-duty treatment records include a January 1986 Report of Medical Examination during the Veteran's Reserve service, which showed the upper extremities and skin were clinically normal on examination. Similarly, the Veteran denied experiencing a painful or "trick" shoulder, skin diseases, tumors, growths, or cancers on the January 1986 Report of Medical History during his Reserve service, and he did not report a right shoulder lump or lipoma at that time. The Veteran also specifically affirmed that he had not experienced any significant change in his health or physical condition. See January 1986 treatment record.

A right shoulder lipoma was first noted in August 2008 VA treatment records. On examination, the Veteran had a small 3-centimeter right shoulder lipoma. Similarly, a July 2009 VA treatment record reported that the Veteran had a right shoulder mass that had been present for more than 10 years. The lipoma was 1.5 inches in size, and the Veteran decided against surgical excision at that time.

The Veteran underwent a VA Agent
Report of Medical History during his Reserve service, and he did not report a right shoulder lump or lipoma at that time. The Veteran also specifically affirmed that he had not experienced any significant change in his health or physical condition. See January 1986 treatment record.

The Veteran underwent a VA Agent Orange Registry examination in April 2017. The Veteran was diagnosed with a subcutaneous lipoma on the right upper back.

With regards to direct service connection, an April 2025 VA examiner reflected the Veteran's reports of a large right shoulder lipoma that was painful and that the Veteran reported that the lipoma had onset in the "1980s." After reviewing the claims file, to include the December 2024 toxic exposure risk activity memorandum, a physical examination of the Veteran, and reviewing the medical literature, the examiner concluded it was less likely than not that the right shoulder lipoma was caused by either a single toxic exposure risk activity exposure or the synergistic combined effects of all the Veteran's toxic exposure risk activity exposures. The examiner explained that a lipoma is a benign subcutaneous tumor of fat cells, with a cause that is not yet known to the medical community. The examiner also noted that lipomas are common with approximately one in every thousand persons having a lipoma throughout their lifetime and that lipomas were also slightly more common in males. The examiner indicated that a review of the medical literature also did not support the conclusion that it was at least as likely as not that lipomas were related to the relevant toxic exposure risk activities, including those conceded during the Veteran's active-duty service. Thus, the examiner opined that the Veteran's currently diagnosed right shoulder lipoma was unrelated to service.

A May 2025 VA examiner opined that it was less likely than not that the right shoulder lipoma was caused by each toxic exposure risk activity, by the combined, synergistic effects of all toxic exposure risk activity, after considering all potential exposures during service. The examiner again explained that a lipoma is a benign subcutaneous tumor of fat cells, with a cause that is not yet known to the medical community and that lipomas are common and found in approximately one in every thousand people throughout their lifetime. The examiner noted that they are slightly more common in males and the medical literature did not support a conclusion that lipomas were related to toxic exposure risk activity, including those conceded during the Veteran's service.

The Board finds the April 2025 and May 2025 VA opinions, taken together, are adequate to decide the appeal. The April 2025 and May 2025 VA examiners considered all evidence of record after thorough review of the claims file, including lay statements properly weighed. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2009); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A] medical opinion...must support its conclusion with an analysis the Board can consider and weight against contrary opinion"). Furthermore, the April 2025 and May 2025 medical examination reports contained clear conclusions with supporting data and a thorough rationale. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301. Therefore, the April 2025 and May 2025 VA opinions are therefore afforded probative weight. There are no contrary opinions of record.

The Board also considered whether the right shoulder lipoma could be related to herbicide agent exposure. VA regulations do not include lipomas as a presumptive disability associated with herbicide agent exposure; therefore, presumptive service connection is not warranted. See 38 C.F.R. §§ 3.307, 3.309(e). Although presumptive service connection based on herbicide agent exposure does not preclude a veteran from establishing service connection with proof of actual direct causation, this theory of entitlement was specifically considered in the May 2025 medical opinion, which did not find a link between the Veteran's right shoulder lipoma and herbicide agent exposures on a direct basis. Thus, service connection for a right shoulder lipoma as due to herbicide agent exposure is not warranted.

Similarly, the Board considered whether the right shoulder lipoma could have been caused by radioactive compound exposure. As noted above, the Veteran does not meet the criteria for a radiation-exposed veteran, a lipoma is not a radiogenic disease, and presumptive service connection is not
3.309(e). Although presumptive service connection based on herbicide agent exposure does not preclude a veteran from establishing service connection with proof of actual direct causation, this theory of entitlement was specifically considered in the May 2025 medical opinion, which did not find a link between the Veteran's right shoulder lipoma and herbicide agent exposures on a direct basis. Thus, service connection for a right shoulder lipoma as due to herbicide agent exposure is not warranted.

Similarly, the Board considered whether the right shoulder lipoma could have been caused by radioactive compound exposure. As noted above, the Veteran does not meet the criteria for a radiation-exposed veteran, a lipoma is not a radiogenic disease, and presumptive service connection is not warranted. However, the April and May 2025 VA opinions also considered whether the right shoulder lipoma was caused by radioactive compound exposure on a direct basis, and the examiner determined it was not. Thus, service connection for a right shoulder lipoma as due to radiation exposure is not warranted.

Furthermore, the Veteran has not specifically asserted that the right shoulder lipoma had onset during service. In fact, the upper extremity and skin examinations were clinically normal at the discharge medical examination from active service in June 1984 and from his Reserve service in January 1986. Furthermore, the Veteran specifically denied having a tumor or growth at separation from the Reserves in the January 1986 Report of Medical History. Although the April 2025 VA examination noted the Veteran reported that the right shoulder lipoma had onset in the "1980s" and a July 2009 VA treatment record noted he reported that the lipoma had been there for "more than 10 years," these statements are non-specific and are not probative to place onset of the lipoma during service. The Board affords greater evidentiary weight to the affirmative denials of tumors and growths in the January 1986 Report of Medical History, recorded contemporaneously with his reports, than later statements to the contrary because they were made in closer proximity to service and are more likely to be accurate. In addition, medical records do not report the existence of a lipoma until 2008. Thus, the Board finds that the Veteran's claimed lipoma did not have its onset during service.

In reaching this determination, the Board has also considered the lay assertions of record, including the contentions of the Veteran in support of a medical nexus. The Veteran generally contended that he had a right shoulder lipoma that is due to his service. As a lay person, the Veteran was competent to report observable symptoms. See Washington v. Nicholson, supra; see also Barr v. Nicholson, 21 Vet. App. 303 (2007); Layno v. Brown, 6 Vet. App. 465 (1994). Lay evidence may be competent on a variety of matters concerning the nature and cause of disability. Jandreau, 492 F.3d at 1377 n.4. In addition, laypersons may, in some circumstances, opine on questions of diagnosis and etiology. See Davidson v. Shinseki, supra. However, the matter of a medical etiology for a disability not capable of lay observation, such as that of a bilateral eye disorder, is a matter within the province of trained medical professionals. See Jones v. Brown, 7 Vet. App. 134, 137-138 (1994). In the instant case, there is no suggestion that prior to his death the Veteran had developed an expertise in the diagnosis and/or etiology for a right shoulder lipoma. Therefore, as he did not have the appropriate medical training and expertise to competently diagnose nor provide an etiology opinion as to a right shoulder lipoma, the lay assertions in this regard have no probative value. Jandreau v. Nicholson, supra; see also Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007) (explaining that while the claimant is competent in certain situations to provide a diagnosis of a simple condition such as a broken leg or varicose veins, the claimant is not competent to provide evidence as to more complex medical questions).

Accordingly, the Board finds that service connection for a right shoulder lipoma is not warranted. The appeal is denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, supra.

REASONS FOR REMAND

1. Entitlement to service connection for bilateral eye disorders is remanded.

The Veteran contends that the currently diagnosed eye disabilities had onset during or are otherwise related to service.

Accordingly, the Board finds that service connection for a right shoulder lipoma is not warranted. The appeal is denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, supra.

REASONS FOR REMAND

1. Entitlement to service connection for bilateral eye disorders is remanded.

The Veteran contends that the currently diagnosed eye disabilities had onset during or are otherwise related to service.

The Board previously remanded these matters to obtain etiology opinions as to each of the Veteran's eye disabilities other than his refractive error. While most recently on remand, the AOJ obtained the required medical opinions in November 2024 for the currently diagnosed pterygia, pinguecula, dry eye syndrome, blepharitis, and conjunctivitis. Unfortunately, the November 2024 VA opinion is inadequate in its current form and did not fully address the January 2022 Board remand directives.

The Board has reviewed the November 2024 VA opinion as to whether the pterygia/pinguecula clearly and unmistakably pre-existed service and whether it clearly and unmistakably was not aggravated during service. The examiner indicated that the Veteran was diagnosed with a pinguecula during service in a June 1982 service treatment record, which reported that the Veteran noticed "bumps" on his eyes about three to four years prior to that examination. These reports placed the existence of the pterygia around 1978 to 1979, which was before entry into service. The examiner explained that pinguecula can progress into pterygia, but the earliest documented progression into pterygia was in 2022, close to 40 years after his service. Therefore, the examiner concluded that this progression was not military related.

Unfortunately, this opinion is factually inaccurate or requires further explanation. Review of the service treatment records show that a November 1980 service treatment record reported bilateral raised areas on his conjunctiva for the previous two years. He also had redness in the conjunctiva bilaterally for the previous year and blurred vision bilaterally in the mornings. He was diagnosed with allergic rhinitis and bilateral synechia. An April 1981 Report of Medical Examination for security guard school noted that he had pterygium. He was sent for an ophthalmological consultation for bilateral pterygia in July 1982. The medical records indicated that he first noticed bumps three to four years earlier with slow growth. The impression was pterygium. The Veteran was diagnosed with pterygium, not a pinguecula, during service, and without further explanation, the examiner's conclusion that the pinguecula did not progress into pterygia until 40 years after service does not correspond with the diagnoses of pterygia in the service treatment records. Therefore, this opinion is inadequate in its current form to decide the claim.

Additionally, after the most recent January 2022 remand, the Veteran was diagnosed with incipient nuclear sclerotic cataracts in both eyes. See August 2022 VA treatment records. The January 2022 Board decision indicated that a VA medical opinion should be obtained as to the nature and etiology of the Veteran's eye disabilities. Although the Board included a list of the current diagnoses found in the record as of January 2022 ("to include bilateral pterygia, mild bilateral blepharitis, mild bilateral dry eye, mild bilateral pinguecula, and mild chronic bilateral conjunctivitis"), this list was not exhaustive. The primary purpose of the remand was to obtain etiology opinions as to the Veteran's eye disabilities that cause "vision problems." See Clemons v. Shinseki, 23 Vet. App. 1 (2009). Thus, on remand, a VA opinion should be obtained as to the nature and etiology of the bilateral cataract disabilities. See Stegall v. West, supra.

Furthermore, the November 2024 VA opinion was obtained before the most recent December 2024 and April 2025 toxic exposure risk activity memorandums were issued. Thus, the November 2024 medical opinion based on an earlier April 2024 toxic exposure risk activity memorandum that found the Veteran was not exposed to toxic exposure risk activity in service is based on a faulty factual premise.

Of note, diseases of the eyes have been found to have no association with herbicide agent exposure. Thus, when the examiner is providing the toxic exposure risk activity opinion, herbicide agent exposure should not be considered as an etiology or as part of the opinion addressing the synergistic, combined effects of all toxic exposure risk activities and all exposures for the
.

On remand, an opinion addressing the nature and etiology of the Veteran's claimed bilateral eye disorder should be obtained. Barr v. Nicholson, supra

The matter is REMANDED for the following action:

1. The Veteran should be given the opportunity to identify any outstanding private or VA treatment records relevant to the claim on appeal. After obtaining any necessary authorization from the Veteran, all outstanding records should be obtained, to include updated VA treatment records.

For private treatment records, make at least two (2) attempts to obtain records from any identified sources. If any such records are unavailable, inform the Veteran and his representative and afford him an opportunity to submit any copies in their possession.

For federal records, all reasonable attempts should be made to obtain such records. If any records cannot be obtained after reasonable efforts have been made, issue a formal determination that such records do not exist or that further efforts to obtain such records would be futile, which should be documented in the claims file. The Veteran must be notified of the attempts made and why further attempts would be futile, and allowed the opportunity to provide such records, as provided in 38 U.S.C. § 5103A(b)(2) and 38 C.F.R. § 3.159(e).

2) Following the receipt of outstanding records, schedule the Veteran for a VA examination with an appropriately qualified clinician to determine the nature and etiology of the Veteran's claimed bilateral eye disorders. The entire claims file, to include a copy of this Remand, should be made available to the examiner, and all indicated tests should be conducted. Further physical examination is left to the discretion of the examiner.

After a thorough review of the claims file, the examiner must address the following:

(A) Identify each of the Veteran's currently diagnosed eye disabilities, whether identified on physical examination or in the medical records, to include bilateral pterygia, mild bilateral blepharitis, mild bilateral dry eye, mild bilateral pinguecula, mild chronic bilateral conjunctivitis, and bilateral incipient nuclear sclerotic cataracts.

(B) For (1) dry eye syndrome, (2) blepharitis, (3) nuclear cataracts, and (4) conjunctivitis, provide an opinion as to whether each was caused by or was otherwise related to each toxic exposure risk activity in service including chemical gas from his training as a military police officer and the other identified toxic exposure risk activity exposures, except herbicide agent exposure. See VBA Letter 20-24-06 at 12-13, Updated Guidance on Processing Claims Involving the PACT Act (June 12, 2024). The examiner should also consider whether each eye disability was caused by the synergistic, combined effects of the toxic exposure risk activity and the frequency of exposure.

(1) the evidence is clear and unmistakable (obvious, manifest, and undebatable) that the bilateral pinguecula and/or pterygia preexisted service; and

(2) the evidence is clear and unmistakable that the pinguecula and pterygia were not aggravated beyond the natural progression of the disease during service by chemical gasses while training to be a military police officer or other toxic exposure risk activity.

A complete rationale must be provided for each conclusion.

(Continued on the next page)

The medical opinion must support the conclusions reached with an analysis that is adequate for the Board to consider and weigh against other evidence of record; medical opinions must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. If an opinion cannot be expressed without resorting to speculation, ensure that the clinician so indicates and discusses why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge.

KRISTY L. ZADORA

Veterans Law Judge

Board of Veterans' Appeals

Att

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